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The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
Good Faith Estimate Notice for Self Pay Clients
New self-pay mental health clients will receive a "good faith estimate" as required by law.
Standard Notice: “Right to Receive a Good Faith Estimate of Expected Charges” Under the No Surprises Act
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for medical items and services.
● You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
● Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your healthcare provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
● If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
● Make sure to save a copy or picture of your Good Faith Estimate.
For questions or more information about your right to a Good FaithEstimate, visit www.cms.gov/nosurprises or call (800) 368-1019.